OLD-TAVR score to predict 2-year mortality in patients aged 75 years and more undergoing transcatheter aortic valve replacement.

PURPOSE: Decision-making on transcatheter aortic valve replacement (TAVR) in patients aged 75 years and older is complex. It could be facilitated by the identification of predictors of long-term mortality. This study aimed to identify predictors of 2-year mortality to develop a 2-year mortality risk score. METHODS: Cohort study of consecutive patients aged ≥ 75 years who underwent TAVR after a comprehensive geriatric assessment (CGA) at our university hospital between 2012 and 2019. Predictors of 2-year mortality were determined using multivariable Cox regression. A point-based predictive model was developed based on risk factors and subsequently internally validated by fivefold cross-validation. RESULTS: The 345 patients (median age 87 years, 54% women) were fit/vulnerable (32%), mildly frail (37%), or moderately/severely frail (31%). The overall 2-year mortality rate was 26%, predicted by atrial fibrillation, hemoglobin ≤ 10 g/dL, age ≥ 87 years, BMI ≤ 24, eGFR ≤ 50 ml/min, and moderate/severe frailty. The risk score (range 0-12), named OLD-TAVR score, for 2-year mortality showed good discriminative power (AUC 0.70) and remained consistent after fivefold cross-validation (cvAUC 0.69). A risk score ≥ 8 (prevalence 20%) predicted a 45% (95%CI: 34-58%) two-year mortality, with high specificity (86%) and good positive predictive power (+ LR 2.43). CONCLUSION: A 2-year mortality risk score (OLD-TAVR score) for very old patients undergoing TAVR was developed based on six bio-clinical items. A score ≥ 8 identified patients in whom 2-year mortality was very high and thereby the TAVR futile. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: Study protocol B403, 26/09/2022, retrospectively registered.

Care of elderly people by the general practitioner and the geriatrician in Belgium: a qualitative study of their relationship.

OBJECTIVES: The care of elderly people is a large part of a general practitioner's work. The growing elderly population means that the medical community must give thought to the management of their care. Within this large field, we focused on the relationship between general practitioners and hospital geriatricians. METHODS: FOCUS GROUP DISCUSSIONS WERE PERFORMED TO DESCRIBE THE COLLABORATION BETWEEN GENERAL PRACTITIONERS AND HOSPITAL GERIATRICIANS: four of these focus groups contained only general practitioners, two groups contained only hospital geriatricians, and one group was made up of general practitioners and hospital specialists. Participants were invited to speak about bad or good experiences of intercollaboration. The discussions were recorded, transcribed, and coded. RESULTS: AN IMPORTANT REGIONAL DISPARITY WAS OBSERVED: better relationships and easier collaboration were reported in those regions that benefit from a wider range of geriatric services. In areas with few geriatric services, doctors knew little of other professionals and reported suspicion and even conflicts. Positive experiences and communication favor good relationships. CONCLUSIONS: THE COLLABORATION BETWEEN GENERAL PRACTITIONERS AND HOSPITAL GERIATRICIANS SHOULD BE ENHANCED: information, exchanges, and reflection on roles and competencies are essential.